Age Specific Nursing Care

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A patient, aged 77 years, has Alzheimer's disease. She goes to day care during the week and is otherwise cared for by her daughter and grandchildren. The nurse at the day care center noticed multiple bruises on the patient's palms, elbows, and buttocks. When the daughter arrived to pick her up, the nurse discussed her observations. The daughter became defensive and said that her mother was very difficult to manage. She stated, "My mother is not my mother anymore. She is confused, and she wanders all night. We have to watch her constantly. Last night I fell asleep, and she fell down the stairs. Sometimes she cannot recognize me and accuses me of trying to poison her. I can't concentrate at work, and it's wrecking the family. Sometimes I just cannot bear it." Which nursing diagnosis would be most important to address for this family?

  • A. Knowledge deficit pertaining to dementia
  • B. Grieving related to mother's deterioration
  • C. Risk for injury related to cognitive impairment
  • D. Caregiver role strain related to increased care needs
Correct Answer: D

Rationale: The correct nursing diagnosis to address in this scenario is D: Caregiver role strain related to increased care needs. This is the most important as it focuses on the daughter's challenges and emotional burden due to her mother's condition. The daughter's statements reveal feelings of overwhelm, guilt, and exhaustion, which are key indicators of caregiver role strain. By addressing this nursing diagnosis, the healthcare team can provide support and resources to help the daughter cope with the demands of caring for her mother.

Choice A (Knowledge deficit pertaining to dementia) is not the most important in this situation as the daughter's issue is not lack of knowledge but rather emotional stress. Choice B (Grieving related to mother's deterioration) is not the priority as addressing the daughter's emotional strain is more urgent than addressing grief. Choice C (Risk for injury related to cognitive impairment) is also important but not as immediate as addressing the caregiver's emotional well-being.

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A client displays disorganized thinking, difficult-to-follow speech, and silly, inappropriate affect. The client isolates himself from other clients and staff, ignores unit activities, and often seems to be listening and responding to unseen stimuli. This client's behavior most closely conforms to the characteristic behavior of:

  • A. Residual schizophrenia
  • B. Schizoaffective disorder
  • C. Paranoid schizophrenia
  • D. Disorganized schizophrenia
Correct Answer: D

Rationale: The correct answer is D: Disorganized schizophrenia. The client's symptoms of disorganized thinking, difficult-to-follow speech, inappropriate affect, social withdrawal, and hallucinations (responding to unseen stimuli) align with the diagnostic criteria for Disorganized Schizophrenia. This subtype is characterized by disorganized behavior, speech, and affect, as well as social withdrawal and hallucinations.

A: Residual schizophrenia does not involve active psychotic symptoms like hallucinations or delusions, which are present in the client's behavior described.
B: Schizoaffective disorder combines symptoms of schizophrenia and mood disorders, and the client's symptoms do not strongly suggest a mood disorder component.
C: Paranoid schizophrenia typically involves prominent delusions and auditory hallucinations, which are not emphasized in the client's behavior described.

A type of delusion in which a patient claims that her genitals have disappeared without her knowledge is called

  • A. Hypochondriacal
  • B. Amorous
  • C. Reference
  • D. Nihilistic
Correct Answer: D

Rationale: Nihilistic delusions involve beliefs that parts of the body or the self have ceased to exist or are destroyed.

Behaviorists would say that self-defeating behaviors are maintained by immediate reinforcement in the form of

  • A. relief from anxiety
  • B. defending the ego
  • C. protecting one's self-image
  • D. avoiding existential anxiety
Correct Answer: A

Rationale: Behaviorists argue self-defeating actions persist because they provide short-term anxiety relief.

Which characteristics are most likely in a sexual perpetrator? Select all that apply.

  • A. Male.
  • B. Female.
  • C. Stranger.
  • D. Age 30 or younger.
Correct Answer: A

Rationale: Step 1: Research shows that the majority of sexual perpetrators are male.
Step 2: Societal norms and power dynamics often contribute to male perpetration.
Step 3: Males are more likely to have societal privilege and opportunity to commit sexual offenses.
Step 4: Gender stereotypes and toxic masculinity can influence male behavior towards sexual violence.
Summary: Choice A is correct because statistical data and societal factors support the likelihood of male sexual perpetrators. Choices B, C, and D are incorrect as they do not align with the established patterns and research on sexual perpetration.

Which nursing intervention will assist a client being treated in the Emergency Department for extensive soft tissue injuries to disclose an experience of domestic violence?

  • A. Interviewing her in the presence of another professional
  • B. Speaking with the client in the absence of her husband
  • C. Providing a safe, nonintimidating environment
  • D. Allowing the client to initiate the topic of violence
Correct Answer: C

Rationale: Rationale for Correct Answer (C): Providing a safe, nonintimidating environment is crucial to encourage the client to disclose domestic violence. This approach helps establish trust and confidentiality, making the client feel secure to share sensitive information. It creates a conducive setting for open communication without fear of repercussions.

Summary of Incorrect Choices:
A: Interviewing her in the presence of another professional may not ensure privacy and could potentially increase the client's discomfort or fear of being overheard.
B: Speaking with the client in the absence of her husband might not guarantee safety and confidentiality, as the client may still feel threatened or hesitant to reveal the abuse.
D: Allowing the client to initiate the topic of violence puts the burden on the client, who may already be feeling overwhelmed or unable to bring up the sensitive issue without support and encouragement.

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